Healthcare Provider Details

I. General information

NPI: 1912467291
Provider Name (Legal Business Name): DANIEL MATTHEW RICKMAN CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

IV. Provider business mailing address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

V. Phone/Fax

Practice location:
  • Phone: 205-421-2088
  • Fax: 205-278-7660
Mailing address:
  • Phone: 205-421-2088
  • Fax: 205-278-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-166704
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-166704
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: